Community Service Application

PLEASE READ BEFORE COMPLETING THE APPLICATION

We no longer accept community service applications from or for anyone under 16 years of age.
We cannot accept violent offenses (battery, assault, etc.).
You must provide ALL information in order for your application to be considered.
* * * * * * * * *

Please complete the form below, and we will be in touch within a week with available community service hours.

You may be asked to provide more information about your infraction/offense before approval is made.

We reserve the right not to accept all applicants.

Legal Name

First Name

Last Name

Phone

(###)

###

####

Drivers License Number

Age

You must be at least 16 years of age to complete community service with us.

Type of Infraction/Offense Resulting in Community Service

Date of Infraction/Offense

State and County in Which Infraction/Offense Occured

How many total hours do you need?

At which location do you wish to do your community service?

Titusville Thrift Store (Open 9 a.m. - 6 p.m. Monday through Saturday and 10 a.m. - 5 p.m. on Sunday)

Melbourne Thrift Store (Open 9 a.m. - 6 p.m. Monday through Saturday and Closed on Sunday)

NOT AVAILABLE AT THIS TIME - Adoption Center (We have very limited community service spaces available here)

Please specify your availability (hours/days of the week) for completing your community service hours in the field below:

If under 18, please provide contact information for parent/legal guardian:

Please read carefully before checking the box and submitting your application:

I understand and agree that submitting this application form does not automatically register me as an SPCA of Brevard Community Service Worker and that there may be certain qualifications I must meet, including the acceptance of established policies and procedures before I begin. I understand that I will not be allowed to handle animals at the SPCA unless specifically asked to by staff and that the bulk of my community service will be geared toward cleaning kennels and general upkeep of the adoption center. By submitting this form, I attest that the information I have provided on the form is true. I agree to hold harmless the SPCA of Brevard, its employees, directors and insurance carriers from any and all claims, damages and judgements which I may have now or in the future against the SPCA of Brevard in all matters pertaining to my service as an SPCA of Brevard Community Service Worker.

I agree

Community Service Application

Location

Mailing Address

Hours

Contact

Community Service Application

Location

Mailing Address

Hours

Contact

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